NIH National Institute or Mental Health (https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd)

What disorders are related to ASD?

Certain known genetic disorders are associated with an increased risk for autism, including Fragile X syndrome (which causes intellectual disability) and tuberous sclerosis (which causes benign tumors to grow in the brain and other vital organs) — each of which results from a mutation in a single, but different, gene. Recently, researchers have discovered other genetic mutations in children diagnosed with autism, including some that have not yet been designated as named syndromes. While each of these disorders is rare, in aggregate, they may account for 20 percent or more of all autism cases.

People with ASD also have a higher than average risk of having epilepsy. Children whose language skills regress early in life — before age 3 — appear to have a risk of developing epilepsy or seizure-like brain activity. About 20 to 30 percent of children with ASD develop epilepsy by the time they reach adulthood. Additionally, people with both ASD and intellectual disability have the greatest risk of developing seizure disorder.

How is ASD diagnosed?

ASD symptoms can vary greatly from person to person depending on the severity of the disorder. Symptoms may even go unrecognized for young children who have mild ASD or less debilitating handicaps. Very early indicators that require evaluation by an expert include:

• no babbling or pointing by age 1
• no single words by age 16 months or two-word phrases by age 2.
• no response to name
• loss of language or social skills previously acquired
• poor eye contact
• excessive lining up of toys or objects
• no smiling or social responsiveness

Later indicators include:

• impaired ability to make friends with peers
• impaired ability to initiate or sustain a conversation with others
• absence or impairment of imaginative and social play
• repetitive or unusual use of language
• abnormally intense or focused interest
• preoccupation with certain objects or subjects
• inflexible adherence to specific routines or rituals

Health care providers will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior. Some screening instruments rely solely on parent observations, while others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of ASD, a more comprehensive evaluation is usually indicated.

A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose and treat children with ASD. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for ASD, children with delayed speech development should also have their hearing tested.

What causes ASD?

Scientists believe that both genetics and environment likely play a role in ASD. There is great concern that rates of autism have been increasing in recent decades without full explanation as to why. Researchers have identified a number of genes associated with the disorder. Imaging studies of people with ASD have found differences in the development of several regions of the brain. Studies suggest that ASD could be a result of disruptions in normal brain growth very early in development. These disruptions may be the result of defects in genes that control brain development and regulate how brain cells communicate with each other. Autism is more common in children born prematurely. Environmental factors may also play a role in gene function and development, but no specific environmental causes have yet been identified. The theory that parental practices are responsible for ASD has long been disproved. Multiple studies have shown that vaccination to prevent childhood infectious diseases does not increase the risk of autism in the population.

What role do genes play?

Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, then the other will be affected between 36 to 95 percent of the time. There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD. In families with one child with ASD, the risk of having a second child with the disorder also increases. Many of the genes found to be associated with autism are involved in the function of the chemical connections between brain neurons (synapses). Researchers are looking for clues about which genes contribute to increased susceptibility. In some cases, parents and other relatives of a child with ASD show mild impairments in social communication skills or engage in repetitive behaviors. Evidence also suggests that emotional disorders such as bipolar disorder and schizophrenia occur more frequently than average in the families of people with ASD.

In addition to genetic variations that are inherited and are present in nearly all of a person’s cells, recent research has also shown that de novo, or spontaneous, gene mutations can influence the risk of developing autism spectrum disorder.  De novo mutations are changes in sequences of deoxyribonucleic acid or DNA, the hereditary material in humans, which can occur spontaneously in a parent’s sperm or egg cell or during fertilization. The mutation then occurs in each cell as the fertilized egg divides. These mutations may affect single genes or they may be changes called copy number variations, in which stretches of DNA containing multiple genes are deleted or duplicated.  Recent studies have shown that people with ASD tend to have more copy number de novo gene mutations than those without the disorder, suggesting that for some the risk of developing ASD is not the result of mutations in individual genes but rather spontaneous coding mutations across many genes.  De novo mutations may explain genetic disorders in which an affected child has the mutation in each cell but the parents do not and there is no family pattern to the disorder. Autism risk also increases in children born to older parents. There is still much research to be done to determine the potential role of environmental factors on spontaneous mutations and how that influences ASD risk.

Do symptoms of autism change over time?

For many children, symptoms improve with age and behavioral treatment. During adolescence, some children with ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood. People with ASD usually continue to need services and supports as they get older, but depending on severity of the disorder, people with ASD may be able to work successfully and live independently or within a supportive environment.

How is autism treated?

There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of the individual. Most health care professionals agree that the earlier the intervention, the better.

Educational/behavioral interventions: Early behavioral/educational interventions have been very successful in many children with ASD. In these interventions therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as applied behavioral analysis, which encourages positive behaviors and discourages negative ones. In addition, family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD.

Medications: While medication can’t cure ASD or even treat its main symptoms, there are some that can help with related symptoms such as anxiety, depression, and obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity in people with ASD. Parents, caregivers, and people with autism should use caution before adopting any unproven treatments

“Autism spectrum disorder (ASD) is a developmental disorder. Someone with ASD may have difficulty with social interaction, communication, and behavior. For example, the earliest signs of ASD are that children may not make eye contact with their parents and may not be aware when someone is talking to them. About 30% of people (about 1 in 3) with ASD have an intellectual disability.”

Centers for Disease Control and Prevention – CDC (https://www.cdc.gov/genomics/disease/autism.htm)

“Statistics by CDC:

• About 1 in 36 children has been identified with autism spectrum disorder (ASD) according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network.
• ASD is reported to occur in all racial, ethnic, and socioeconomic groups.
• ASD is nearly 4 times more common among boys than among girls.”

Centers for Disease Control and Prevention – CDC (https://www.cdc.gov/ncbddd/autism/data.html)

What is autism spectrum disorder?

Autism spectrum disorder (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction. The symptoms are present from early childhood and affect daily functioning.

The term “spectrum” refers to the wide range of symptoms, skills, and levels of disability in functioning that can occur in people with ASD. Some children and adults with ASD are fully able to perform all activities of daily living while others require substantial support to perform basic activities. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, published in 2013) includes Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified (PDD-NOS) as part of ASD rather than as separate disorders. A diagnosis of ASD includes an assessment of intellectual disability and language impairment.

ASD occurs in every racial and ethnic group, and across all socioeconomic levels. However, boys are significantly more likely to develop ASD than girls. The latest analysis from the Centers for Disease Control and Prevention estimates that 1 in 68 children has ASD.

What are some common signs of ASD?

Even as infants, children with ASD may seem different, especially when compared to other children their own age. They may become overly focused on certain objects, rarely make eye contact, and fail to engage in typical babbling with their parents. In other cases, children may develop normally until the second or even third year of life, but then start to withdraw and become indifferent to social engagement.

The severity of ASD can vary greatly and is based on the degree to which social communication, insistence of sameness of activities and surroundings, and repetitive patterns of behavior affect the daily functioning of the individual.

Social impairment and communication difficulties
Many people with ASD find social interactions difficult. The mutual give-and-take nature of typical communication and interaction is often particularly challenging. Children with ASD may fail to respond to their names, avoid eye contact with other people, and only interact with others to achieve specific goals. Often children with ASD do not understand how to play or engage with other children and may prefer to be alone. People with ASD may find it difficult to understand other people’s feelings or talk about their own feelings.

People with ASD may have very different verbal abilities ranging from no speech at all to speech that is fluent, but awkward and inappropriate. Some children with ASD may have delayed speech and language skills, may repeat phrases, and give unrelated answers to questions. In addition, people with ASD can have a hard time using and understanding non-verbal cues such as gestures, body language, or tone of voice. For example, young children with ASD might not understand what it means to wave goodbye. People with ASD may also speak in flat, robot-like or a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Repetitive and characteristic behaviors
Many children with ASD engage in repetitive movements or unusual behaviors such as flapping their arms, rocking from side to side, or twirling. They may become preoccupied with parts of objects like the wheels on a toy truck. Children may also become obsessively interested in a particular topic such as airplanes or memorizing train schedules. Many people with ASD seem to thrive so much on routine that changes to the daily patterns of life — like an unexpected stop on the way home from school — can be very challenging. Some children may even get angry or have emotional outbursts, especially when placed in a new or overly stimulating environment.

“Stress makes it hard for us to relax and can come with a range of emotions, including anxiety and irritability. When stressed, we may find it difficult to concentrate. We may experience headaches or other body pains, an upset stomach or trouble sleeping. We may find we lose our appetite or eat more than usual. Chronic stress can worsen pre-existing health problems and may increase our use of alcohol, tobacco and other substances.

Stressful situations can also cause or exacerbate mental health conditions, most commonly anxiety and depression, which require access to health care.

Stress affects both the mind and the body. A little bit of stress is good and can help us perform daily activities. Too much stress can cause physical and mental health problems. Learning how to cope with stress can help us feel less overwhelmed and support our mental and physical well-being. Stress affects both the mind and the body. A little bit of stress is good and can help us perform daily activities. Too much stress can cause physical and mental health problems. Learning how to cope with stress can help us feel less overwhelmed and support our mental and physical well-being.”

World Health Organization -WHO (https://www.who.int/news-room/questions-and-answers/item/stress)

Here are tips to help manage stress:

1. Take care of your body and mind. This can include regular exercise, adequate sleep, a healthy diet, and relaxation practices. You may want to combine some of these habits for optimal self-care. For example, after a workout stretch your muscles while practicing deep breathing techniques. Eat a nutritious meal while practicing mindfulness of the moment. Get to bed at a decent hour and practice progressive muscle relaxation to help you wind down and fall asleep relaxed.

2. Identify your priorities and establish boundaries. Consider what is most important and valuable to you during the holidays and keep those as priority. This will require you to set boundaries around your priorities. Say no to “lesser” priorities, and ask for help when needed. For example, if exercising regularly is a priority, set boundaries around your time to ensure you’re able to get to the gym on a consistent basis. Similarly, if you want to spend quality time with loved ones you don’t see often, then you may have to say no to other responsibilities. This will keep you from feeling like you’re being pulled in all directions. It may also help reduce the risk of feeling resentment or disappointment once the holidays are over.

3. Be realistic. Assess your expectations of yourself and others. Try not to expect the holidays to go perfectly, and realize that you do not have to be perfect. You don’t have to prepare an ultra-fancy meal or give the perfect gift to every friend and family member. Practice some relaxation skills (mentioned above) to help clear your mind and determine what’s most realistic and what’s not. If family conflict has popped up in past holidays, don’t expect there to be perfect peace and harmony this year. Instead, plan ahead for your healthy response to conflict that may arise and be prepared to set boundaries if needed.

4. Cultivate gratitude. There is growing research on the benefits of gratitude, particularly on physical, psychological, and relational well-being. An “attitude of gratitude,” as Dr. Robert Emmons (a leading researcher on the science of gratitude) calls it, has been linked to greater stress tolerance, increased positive emotions, better sleep, improved physical health, and healthier relationships. It can be beneficial to create a daily habit of remembering what you are thankful for. Keeping a gratitude list at the beginning or end of each day is a great way to do this. If certain well-meaning friends or family members start stretching your patience, remind yourself of why you are thankful to have them in your life.  Which at times may not be easy so walk away and get a a breath or two by taking a walk.

5.  Maintain the safety interventions needed to prevent

Life can be stressful—you may feel stressed about performance at school, traumatic events (such as a pandemic, a natural disaster, or an act of violence), or a life change. Everyone feels stress from time to time.

What is stress?

Stress is the physical or mental response to an external cause, such as having a lot of homework or having an illness. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time.

What is anxiety? Anxiety is your body’s reaction to stress and can occur even if there is no current threat.

Trigger Reactions to Stress by the human body:

Increased heart rate and respirations. Increased blood pressure. Upset stomach, nausea, diarrhea. Increased or decreased appetite which may be accompanied by weight loss or gain.

If that anxiety doesn’t go away and begins to interfere with your life, it could affect your health. You could experience problems with sleeping, or with your immune, digestive, cardiovascular, and reproductive systems. You also may be at higher risk for developing a mental illness such as an anxiety disorder or depression.

Everyone experiences stress, and sometimes that stress can feel overwhelming! You may be at risk for an anxiety disorder if it feels like you can’t manage the stress and if the symptoms of your stress:

• Interfere with your everyday life.
• Cause you to avoid doing things.
• Seem to be always present.

Learning what causes or triggers your stress and what coping techniques work for you can help reduce your anxiety and improve your daily life. It may take trial and error to discover what works best for you. Here are some activities you can try when you start to feel overwhelmed.

What to do if stress triggers and to help yourself ; when picking up on it; some ideas:

• Keep a journal.
• Download an app that provides relaxation exercises (such as deep breathing or visualization) or tips for practicing mindfulness, which is a psychological process of actively paying attention to the present moment.
• Exercise, and make sure you are eating healthy, regular meals.
• Stick to a sleep routine, and make sure you are getting enough sleep.
• Avoid drinking excess caffeine such as soft drinks or coffee.
• Identify and challenge your negative and unhelpful thoughts.
• Reach out to your friends or family members who help you cope in a positive way.

One way of looking at life is whatever challenges comes your way know you will survive and for any losses you may experience when looking back on them take the positive aspects or memories not the negative that builds a bad effect on you (Ex. Insomnia to depression to high blood pressure to alcoholism to drugs).  

A positive effect can be as simple as a smile when reflecting memories, which FYI allows less frowning that will cause less wrinkles on the forehead, as we get older.  Sometimes it’s not that simply and when it gets harder take up a constructive way of dealing with it (Ex. Work out at your level, walking, singing, go to a comedy movie, get together with friends go out, and do anything that gets your mind off of the stress and even out of your body through work out at the gym to just biking or walking.).

For starters stress is a body reaction to CHANGE.  How to you look at change?  Easy, positive in someway!  It may not appear easy at first but try to look at this change as a sense of difficulty yet a challenge with a victory in the end, if approached right.

Let us take the following challenges we face in life, for example –  Having a child leave home for college or marriage, losing a home with this economy, a loss of a friend in your life:  How do you look at these experiences positive?

1.)  Well for the child I would be so happy for her or him starting college life with my worries but know I raised her or him well and if he makes mistakes on the way he or she will learn to get up off the ground and fix them knowing he or she can come to me or dad whenever he has the need or if we sense a problem we would address it (Its part of life=growing up).

2.)  Another aspect to look at regarding this stress is there is loss in the parent role so fill up that loss with a new hobby, or get active in whatever organization you are in (Ex. Church, Temple, School, to just taking up ceramics or do more traveling with your spouse and friends). Help out the community you live in and assist in organizations that you feel do help the society in your city or town or village you live in.  I had my falls with the stresses that I have come across in my lifetime but you got to get up every time to stand again, some quicker than other times.  Love ones we loose I deal with in a positive way in knowing their in heaven, a lot better than here also looking at the fond memories I have of that person with knowing I will see them again when I pass on but trying to keep active with my life which now is hard but with my significant other helping me to get started.

3.)  How do you deal with losing a home with this economy or a business as  well appreciate the good memories you had when you had the home and pick up starting a new life elsewhere with making it a journey down the yellow brick road leading you to where the rainbow is at the end; don’t look at it as a loss.  It may be miserable at first but being a nurse seasoned I know there is always someone worse than I am and no I am not rich (far from it) that I can pick up and by another home.

4.) If you lost a business in the time of COVID-19 due to this long stretch of lockout particularly in NY (take the city alone) or if you just lost a business in general.  It is a hard challenge to come across but there is a new plan and journey for you to restart.  My family was there in losing business or a job including my husband in this COVID-19 but we resolved all job problems and with saving our money, it took time, but we survived.  We have each other and thank God we never lost our home we can say.  We can make through anything as long as we have each other and this is not a happy episode of “Little house on the Prairie” but knowing how to look at life’s challenges positive with negative feelings at first, which is only expected.

The same as Erickson’s stages of death; first denial to anger to bargaining to depression to acceptance and will relive these steps over again during your challenge but will beat it with having a positive approach and knowing how to use effective methods to let your stress go.  Know you will have those Erickson steps replaying over, not even in those steps directly 1 through 5 but know what to do when you relive them like work out, go to a volunteer organization and help out or whatever makes you feel better that does not hurt your health but help it in a positive approach.

Dealing with losing a friend or terminal friend, again the way I look at it is I appreciate the time I had with her or him and know they haven’t left me in spirit (if deceased).   If the person is still living know there are reasons for everything; whatever the cause was for the reason for the relationship in parting, divorce or death for example.  When out of my control I think of how I had a good friendship as opposed to never having one with that individual or thinking I will never see them again.  I accept that nothing lasts forever or indefinitely, with appreciating the time I had with the person and money is just monetary with hoping it gives me good memories if I loose or choose to ever leave it (like a home, car, etc).  I try to cherish each day for being given that gift by God to have ever have met that person and was able to spend time with that person.

Ending note, I look at life this way, whatever positive entity comes in my life may be taken away from me and I should appreciate every moment I spend with that person or creature or career or job or home in my life that I love so much (including my life span that only upstairs knows how long that time factor will be but I try to live a life at its healthiest optimal level with practicing positive behavior which is knowing whatever stressors come my way there is always someone is worse off and thank God for the life I was given which makes me a strong person in facing everything that has come my way, so far.  What has probably helped me is being a RN for over 35 years and working in so many specialty areas that made me see people worse off than me in health and more.

If I don’t deal with stress like this than I can expect complications that may arise, just like for anyone else who looks at challenges coming their way in a negative sense.  You commonly see stress become a negative experience when a person faces continuous challenges/stressors without relief or relaxation between them.  The ending result is the person becomes overworked and stress-related tension builds.  Stress that continues without positive resolution at some level can cause a condition called distress, which is a negative stress reaction.

The physical reactions that happen to your body due to negative stress can be = negative symptoms there is both acute vs chronic.

Stress is a normal part of life; the ones you build up one over another with no resolving them make the stress worse!

Acute VS Chronic Stress to the human body:

Many events that happen to you and around you — and many things that you do yourself (Ex. Work 40 to 60 hrs a week in a highly stressful job, like a policeman) – will put stress on your body.

You can experience stress from your environment, your body, and your thoughts.  You can also cause the stress to impact your body with first just signs and symptoms (s/s) developing, that are listed above, but without relief of the stress these s/s can lead you into a disease/illness forming or even make the diagnose (s) you already have even worse.

Many signs and symptoms pick up when exposed to continual stress or stresses that just build up on top of each other causing some people in developing unhealthy habits, poor dieting, and the lack of desire to be as active as they were which in turn develops conditions that would not have occurred if this negative behavior didn’t happen over a long period of time which has occurred to me and come back but get on top of it or it gets harder to beat!!

This behavior with the stress or stresses you are experiencing increases the probability of health conditions starting to take place in your body or if you’re with certain diagnoses already the stress can possibly impact your body by worsening the condition.

1.) Acute Stress to the human body ( a stress response over short term, immediately reacting):

-Elevated high blood pressure –Headaches –Chest Pain –Upset Stomach   –Insomnia –Grinding of the teeth –Jaw Tension –Teeth grinded down –Irritability –Anger –Panic episodes –Vasoconstriction to our vessels  causing increases to the heart rate –Decreases sex drive –Depression (Research even suggests that stress also can bring on or worsen certain symptoms or diseases.)

Stress costs American industry more than $300 billion annually.  The lifetime prevalence of an emotional disorder is more than 50%, often due to chronic, untreated stress reactions.

2.) Chronic Stress to the human body (a  stress response over long term stress=medical conditions arrising):

-ADD or ADHD –Panic disorders –High blood pressure –Anti-arrhythmias -Cardiac Disease -Diabetes 1 or Diabetes 2  -Stroke –Irritable Bowel Syndrome –Weight Gain/Obesity –Fibromyalgia –Complex Regional Pain Syndrome –ETOH -Depression and so much more.

Learn how to beat stress and help your health and no one can do it but do!  Today we learned what stress is, trigger reactions by the body in stress, what to do if it triggers, the symptoms immediate vs. long term stress challenges we come across in life. Check out tomorrow’s topic Part II – tips on dealing with stress!

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You’re more likely to develop gout if you have high levels of uric acid in your body.

Factors that increase the uric acid level in your body include:

• Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
• Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
• Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.

People with gout can develop more-severe conditions, such as:

• Recurrent gout.

  Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.

• Advanced gout.

  Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.

• Kidney stones.

  Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.